what are the majority of your 'waiting room' cases that you treat? (besides trauma)

[OwlMyste]

hello,

I had to be rushed to the ER a couple days ago because my whole body was tingling like it was asleep, I had shortness of breath, my speech was slurred and my arms and hands drew up and locked themselves. The doctor there...Dr. Jorg Moreno, performed some blood tests and found out my potassium was low and my epilepsy meds were low....he said I had a breakthru seizure because of the stress I had been going thru lately....(for all of you that don't know, my parents separated a couple weeks ago...) It got me to wondering....are most cases in the ER...(besides the obvious trauma)...minor cases? like for another example my brother...last year he had to be taken to the ER because of a 104.2 degree temperature...he told me he had darkened urine and was sick...but the er dr just treated him with IV antibiotics and he was fine.....(I consider it minor if its not life threatening or if its treatable with just a few things)....could you please clarify for me? Its just a curious thought to know what a majority of your cases in the waiting room are...(besides the obvious trauma).....THANKS!

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[EMIMG]

I think that it varies by institution as well as by time of the shift. For instance, I know that there are some institutions where different residents are assigned a different acuity of patients. Some residents will only see the category 1s and 2s, and there will be others that will see the category 3s and 4s.

Still, there are other times of the day that will be busier. I would venture a guess to say that more admissions happen during the morning or afternoon hours than overnight. I know from a personal standpoint, we see a lot of intoxicated patients and assaults at the overnight shift. These patients typically are not admitted.

Having just completed my 2nd year in a 3 year program, I went back to take a look at my patient logs. The program at which I am a resident does not really designate a difference between who sees what patients (with the exception of our traumas and code 1 resuscitations which are typically run by a 2nd or 3rd year). On the patients that I was primarily responsible, I had an admission rate of 42.7% at our main hospital and an admission rate of 26.2% at our community hospital.

Basically, it varies by institution, and time of shift.

With that being said, we still see plenty of parents who bring their children in at 2am via EMS because the cough got "worser". Or, the parent who brings the ~4 month old in because they did not have a bowel movement for 24 hours but then dumps a load out in triage. Or the first time mom that brings her 5 day old in the day after being discharged from the hospital because every time she feeds the little one, a bowel movement follows.........Ahhhh the stories one could tell.

 

[Apollyon]

Nationally, the winner is abdominal pain - at a whopping 5%. Accidents are only 1.5% - the surprising thing being that "everything else" accounts for about 52% - in other words, one case of everything.

When I'm a little less lazy, I'll hook you up with the link that has the data.

When I was a student, though, there seemed to be trends - at Newark-Beth Israel, it was abscesses and GYN problems. At SUNY-Buffalo, I had two patients come up pregnant via the standard urine HCG that every menstruating female gets. Go figure.

 

[Chode]

Originally posted by OwlMyste
hello,

I had to be rushed to the ER a couple days ago because my whole body was tingling like it was asleep, I had shortness of breath, my speech was slurred and my arms and hands drew up and locked themselves. The doctor there...Dr. Jorg Moreno, performed some blood tests and found out my potassium was low and my epilepsy meds were low....he said I had a breakthru seizure because of the stress I had been going thru lately....(for all of you that don't know, my parents separated a couple weeks ago...) It got me to wondering....are most cases in the ER...(besides the obvious trauma)...minor cases? like for another example my brother...last year he had to be taken to the ER because of a 104.2 degree temperature...he told me he had darkened urine and was sick...but the er dr just treated him with IV antibiotics and he was fine.....(I consider it minor if its not life threatening or if its treatable with just a few things)....could you please clarify for me? Its just a curious thought to know what a majority of your cases in the waiting room are...(besides the obvious trauma).....THANKS!

were you at Charity?

 

[OwlMyste]

Originally posted by Chode
were you at Charity?

I was at Sylvan Grove Hospital....why do you ask???

 

[ERMudPhud]

Well you wanted to know...


Here is a list of the chief complaint and/or diagnosis of the patients I saw during two 10:00 p.m.-6:00 a.m shifts last weekend. As you can see many don't really need to be in the ER in the middle of Friday or Saturday night.

1. Too Drunk to breath-intubated (peds) 2. Chronic knee pain 3. 2nd degree burns to palm of hand 4. Allergic angioedema 5. Supraventricular tachycardia 6. Etoh withdrawl 7. lung cancer progression 8. etoh intox 9. dental abcess 10. wound dehiscense 11. drunk, dove head first into wading pool showing off to girls 12. etoh, assault, facial lacs 13. punched in the jaw 14. hyperkalemia (blood drawn last week and results just called to PCP) 15. Diverticulitis 16. sigmoid volvulus 17. spider/insect bite
18. asthma 19. dental abcess 20. punched in arm 21. dental abcess 22. etoh intox 23. allergic rxn (peanuts) 24. diarrhea 25. etoh intox 26. punched in face 27. urinary retention 28. contact dermatitis 29. pneumonia, hyponatremia, altered mental status, sick 30. insect bite
31. urinary retention 32. wrist sprain 33. chronic knee pain 34. polysubstance overdose suicide 35. reflux 36. punched in head 37. Pediatric etoh overdose 38. depression 39. urosepsis with obstructing kidney stone, too fat for CT scanner 40. bilaterall calcaneal fxs (running from police jumped off building-two days ago) 41. diverticulits 42. arm abrasions 43. hand contusion (see punched in face above) 44. aspirin overdose, suicide, quite sick 45. PID 46. etoh intox 47. unstable angina 48. abd pain, likely appendicitis, left AMA

In addition my PA saw the following patients with me being more or less involved depending on the patient.

1. Threatend miscarriage 2. Threatened miscarriage 3. hand burn 4. wrist sprain 5. palpitations (anxiety) 6. punched in face 7. knee contusion 8. corneal foreign body 9. chronic back pain 10. PID 11. Otitis media 12. Otitis media 13. UTI 14. crushed thumb 15. ankle fracture 16. rib pain 17 UTI 18. appendicitis

 

[edinOH]

That's quite a few face punches. Was Mike Tyson in town? Actually I guess that would be ear avulsions...

 

[Doc Ivy]

dumb question alert:

what is urinary retention? Is it really as simple as not being able to pee? Is it painful, how is it resolved--- catheterizaton?

Thx

 

[Febrifuge]

Dumb answer alert:

Yes, sometimes, and yes.

-Feb
(knee surgery 1990, and guess how I reacted to the general?)

 

[Jalby]

smart answer:

Inability to voluntarily pee, not to painfull, and give a drug that relaxes the urinary spincter. Generally a Acetylcholine agonist such as bechanol.